Recommended Citation
Haider S, Hassan S. A Unique Complication of Roux-en-Y Gastric Bypass: Relapse of Atypical Anorexia Leading to Persistent Hypoglycemia in a Transgender Patient. Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Abstract
Introduction/Background:
Post-bariatric hypoglycemia is a known complication of Roux-en-Y gastric bypass (RYGB), often due to dumping syndrome or, rarely, noninsulinoma pancreatogenous hypoglycemia syndrome (NIPHS), characterized by hyperinsulinemic postprandial hypoglycemia from pancreatic β-cell hyperplasia. Eating disorders, including anorexia, are prevalent in bariatric candidates (up to 17-19% with binge eating or depression per meta-analyses). Though anorexia nervosa relapse, post-surgery is uncommon and underreported. Current guidelines (AACE/TOS/ASMBS 2020) recommend preoperative mental health evaluation but do not view eating disorders as absolute contraindications unless active and untreated.
Description:
A 37-year-old transgender woman (MtF) with prior type 2 diabetes and morbid obesity (>270 lbs) underwent RYGB with paraesophageal hernia repair in November 2023. Preoperative management focused on diabetes control. Postoperatively, she initially felt well but developed dumping symptoms and blood glucose (BG) <90 mg>/dL by late November 2023. She identified trigger foods, leading to dietary restriction, nausea, vomiting, and stress. This progressed to suspected atypical anorexia relapses, requiring behavioral health admission. Hypoglycemia persisted (<60 mg>/dL regularly on CGM: 5% time low, 1% very low; average BG 95 mg/dL). Interventions included nasogastric feeding tube, then permanent gastrostomy tube with continuous feeds (~8 hours/day) alongside limited oral intake. She achieved >100 lbs. weight loss but experienced reduced quality of life, multiple admissions, and subspecialty evaluations.
Discussion:
RYGB achieved substantial weight loss and health improvement but triggered dumping, dietary restriction, and atypical anorexia relapse, culminating in severe, persistent hypoglycemia requiring invasive support. This case highlights a rare interplay: surgical anatomy exacerbating restriction in a patient with eating disorder vulnerability, potentially compounded by emerging NIPHS (typically presenting years post-RYGB). Key take-away: Bariatric surgery can precipitate or worsen eating disorders despite preoperative screening, leading to profound quality-of-life declines and complex hypoglycemia. Clinical relevance underscores the need for vigilant postoperative monitoring of mental health and glucose in high-risk patients. Future directions include refined preoperative risk stratification for eating disorder history and multidisciplinary management protocols to prevent such outcomes.
Presentation Notes
Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Full Text of Presentation
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Document Type
Poster
Open Access
Available to all.
A Unique Complication of Roux-en-Y Gastric Bypass: Relapse of Atypical Anorexia Leading to Persistent Hypoglycemia in a Transgender Patient
Introduction/Background:
Post-bariatric hypoglycemia is a known complication of Roux-en-Y gastric bypass (RYGB), often due to dumping syndrome or, rarely, noninsulinoma pancreatogenous hypoglycemia syndrome (NIPHS), characterized by hyperinsulinemic postprandial hypoglycemia from pancreatic β-cell hyperplasia. Eating disorders, including anorexia, are prevalent in bariatric candidates (up to 17-19% with binge eating or depression per meta-analyses). Though anorexia nervosa relapse, post-surgery is uncommon and underreported. Current guidelines (AACE/TOS/ASMBS 2020) recommend preoperative mental health evaluation but do not view eating disorders as absolute contraindications unless active and untreated.
Description:
A 37-year-old transgender woman (MtF) with prior type 2 diabetes and morbid obesity (>270 lbs) underwent RYGB with paraesophageal hernia repair in November 2023. Preoperative management focused on diabetes control. Postoperatively, she initially felt well but developed dumping symptoms and blood glucose (BG) <90 mg>/dL by late November 2023. She identified trigger foods, leading to dietary restriction, nausea, vomiting, and stress. This progressed to suspected atypical anorexia relapses, requiring behavioral health admission. Hypoglycemia persisted (<60 mg>/dL regularly on CGM: 5% time low, 1% very low; average BG 95 mg/dL). Interventions included nasogastric feeding tube, then permanent gastrostomy tube with continuous feeds (~8 hours/day) alongside limited oral intake. She achieved >100 lbs. weight loss but experienced reduced quality of life, multiple admissions, and subspecialty evaluations.
Discussion:
RYGB achieved substantial weight loss and health improvement but triggered dumping, dietary restriction, and atypical anorexia relapse, culminating in severe, persistent hypoglycemia requiring invasive support. This case highlights a rare interplay: surgical anatomy exacerbating restriction in a patient with eating disorder vulnerability, potentially compounded by emerging NIPHS (typically presenting years post-RYGB). Key take-away: Bariatric surgery can precipitate or worsen eating disorders despite preoperative screening, leading to profound quality-of-life declines and complex hypoglycemia. Clinical relevance underscores the need for vigilant postoperative monitoring of mental health and glucose in high-risk patients. Future directions include refined preoperative risk stratification for eating disorder history and multidisciplinary management protocols to prevent such outcomes.
Affiliations
Aurora St Luke’s Medical Center